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My Mouth Is Burning!

Your mouth is burning, but you have not had anything hot to eat or drink. What is going on?

 

It might be Burning Mouth Syndrome (BMS), a very real condition (also known as "stomatopyrosis"). It is painful and frustrating,

and it typically affects middle-aged or older women. Burning mouth syndrome affects nearly 1.3 million Americans.

 

Here is the essential information you might need to know.graphicstock-portrait-of-aged-women-doing-yoga-exercise - SM H0zkv2sF-Z

 

Here are two definitions:

 

The International Association for the Study of Pain defines burning mouth syndrome as "a distinctive nosological entity characterized by unremitting oral burning or similar pain in the absence of detectable mucosal changes, and "burning pain in the tongue or other oral mucous membranes." 

 

The International Headache Society defines it as "an intra-oral burning sensation for which no medical or dental cause can be found."

 

Symptoms of Burning Mouth Syndrome

  • Moderate to severe burning in the mouth
  • Tingling or numbness of the tip of your tongue or elsewhere in your mouth
  • Metallic or bitter taste
  • Dry or sore mouth

Often the symptoms intensify over the course of the day. But the pain usually subsides at night.

According to the Mayo Clinic: “Whatever pattern of mouth discomfort you have, burning mouth syndrome may last for months to years. In rare cases, symptoms may suddenly go away on their own or become less frequent. ... Burning mouth syndrome usually doesn't cause any noticeable physical changes to your tongue or mouth.”

 

Causes of Burning Mouth Syndrome

Sometimes, the cause of burning mouth is easy to identify and diagnose. It is not uncommon, however, to be unable to identify a cause of the burning. Among the possible causes of burning mouth syndrome are the following:

  • Damage to nerves that control taste and pain in the mouth
  • Hormonal changes
  • Dry mouth – often cause by other disorders and medications (Diabetes, Sjogren’s syndrome).
  • Deficiencies in nutrition
  • Oral candidiasis (a fungal infection in the mouth)
  • Acid reflux
  • Poorly fitting dentures, allergies to denture materials
  • Anxiety and depression (although sometimes burning mouth can cause anxiety and depression).

In some cases, more than one of these factors are causing the burning

 

Diagnosing Burning Mouth Syndrome

Diagnosis is typically based on your medical history, an oral examination, and a general medical exam. This might suggest that your primary care physician and your dentist could work together. Some tests are often made to assist in the diagnosis:

  • Blood tests for infections, nutritional deficiencies, diabetes or thyroid conditions.
  • Oral swab test for oral candidiasis.
  • Allergy testing for some foods, denture materials (when appropriate), or other types of allergies.

Treating Burning Mouth Syndrome

Treatment is always individualized based on suspected causes of burning mouth. That said, there are a number of possible treatments, including:

  • Replacing or adjusting dentures
  • Dietary adjustments to respond to nutritional deficiencies
  • Treating contributing illnesses (diabetes, thyroid problems, Sjogren’s syndrome)
  • When possible, changing medications that may be causing or contributing to the problem
  • Taking appropriate medications (as recommended by your physician or dentist) to relieve dry mouth, to treat oral candidiasis, to mitigate pain from nerve damage, to relieve anxiety and depression.

What You Can Do to Manage Burning Mouth Syndrome

  • Sip water frequently
  • Suck on ice chips
  • Avoid hot, spicy foods
  • Avoid mouthwashes that contain alcohol
  • Avoid products that are high in acid
  • Chew sugarless gum
  • Brush your dentures or teeth with baking soda and water
  • Avoid alcohol and tobacco.
 
I Have White Gums! Why?

“White gums seem abnormal. But this morning I looked in the mirror while brushing my teeth and the gums are white. Why did this happen? What does it mean? What do I need to do?”

White gums typically indicate that something is wrong in your mouth. Yet there is no need to panic. White gums can be caused by canker sores or oral cancer or many other problems in between.white gums - paid -shutterstock 211849876

Leading Causes of White Gums

There are a number of common causes of white gums. Some are simple and easily treated. But they can be a symptom of oral cancer. What are these leading causes?

  1. Leukoplakia can turn parts of the gums white. Typically, white patches emerge that cannot be removed with your toothbrush. Although we do not know exactly what causes leukoplakia, many believe there is a connection with tobacco. Most cases are essentially harmless. However, some cases are precancerous or cancerous.
  2. Anemia can turn gums white. Usually caused by Vitamin B12 or Iron deficiencies, Crohn’s disease or celiac disease. Anemia involved a shortage of red blood cells, which carry oxygen and blood through your body. Many people with anemia have very pale skin. Sometimes this includes white gums.
  3. Canker sores can also turn portions of the mouth or gums white. These sores (ulcers) develop in the mouth or on the gums and may be painful. They tend to be oval or round and they typically are a light color in the center, ringed by red. These will not change the color of your entire mouth – just the area of the sore.
  4. Gingivitis, a mild form of gum disease (periodontitis). The most common cause of gingivitis is poor dental hygiene, although some conditions cause dry mouth which also contributes to the condition. About half of all Americans have gingivitis. In time, gingivitis can cause the gums to recede and turn white.
  5. Oral Lichen Planus produces lacy white patches on tongue, gums and inside the mouth. This chronic autoimmune condition may cause pain, gum inflammation, and bleeding gums. This condition puts people at risk of nutritional deficiencies and mouth infections of several kinds. It can also lead to oral cancer.
  6. Thrush is a yeast infection. This causes raised whitish sores on the inside of cheeks, on the tongue or on the gums. Older adults, diabetics, and babies are particularly susceptible to thrush.
  7. Extraction of a tooth. Occasionally, after extracting a tooth the immediately surrounding gums may turn white temporarily. They pink up in a few days.
  8. Professional tooth whitening. This process may cause the gums to appear brighter or white briefly. Normal color typically returns in a matter of hours
  9. Oral Cancer. One symptom of oral cancer is white gums. The American Cancer Society estimates that more than 50,000 Americans will develop oral cancer or oropharyngeal cancer this year.

The causes of white gums can be difficult to differentiate, except those causes that clear up naturally in a matter of hours or days. It is vital that you see your dentist as soon as possible if your gums are white because oral cancer spreads very quickly. Tell the receptionist in your dentist’s office about the problem when you call for an appointment.

Other symptoms of oral cancer include

  • Other mouth sores
  • Bleeding inside your mouth
  • Growths or lumps in your mouth
  • Thickening of the skin inside your mouth
  • Loose teeth
  • Pain in your tongue or jaw
  • Difficulty swallowing or chewing
  • Sore throat

Treatment

The first step in treating white gums is a visit to your dentist. It is important to have a professional check of the area to rule out cancer and to identify the cause of your gums turning white. Different causes of white gums require different treatments. Your dentist will be able to identify the probable cause of the problem. She/he can then treat you or tell you how to treat the problem at home.

If you observe white gums, call to make an appointment with your dentist immediately. It is important to have an examination to rule out cancer or to identify it and begin appropriate treatment.

Although white gums usually are innocuous, sometimes they indicate cancer. My suggestion is that you not panic. Just see your dentist as soon as possible for an evaluation and appropriate treatment.

When we know there is a white gums issue, we make every effort to see you as soon as possible. If you observe white gums, call us for an appointment.

 

 
What You Hate About a Visit to Your Dentist

At Complete Dental Care in Salem Virginia, we want to know what you hate about a visit to your dentist (yes, even if that dentist is us). We do our very best to listen to and respond to your concerns, questions, and fears. If you tell us that something bothers you, we will genuinely try to either stop doing it or find a way to do it in a less offensive way. But you must tell us about your feelings and fears.

 

I read an article recently that has been widely disseminated among dentistry publications. It presents the findings of a poll of what dental patients hate about their dentist, the dental team, or the dental practice they go to. The comments were divided into 5 categories, and the top few responses were included in some detail.dentistry tools - pixabay cco -1514686 1280

 

Category 1 was Pain or Discomfort. This category includes “irrational fears” such as, “What happens if ‘the thing” that scrapes my teeth slips . . . and rips off the side of my face?” This probably is not an irrational fear. But our entire team has many years of experience and follows protective guidelines and practices to prevent such events. If you have real concerns of this kind, tell us. We will be happy to explain what we do to prevent things like this from happening. Some of those who responded to the poll said they dislike the extreme dryness that can result from use of suction in the mouth when we are working. Others said they thought the dentist was too rough. Admittedly, we have not heard these concerns often. But we cannot respond if we don’t know there is a problem. If you are uncomfortable, just raise you hand and tell us. Then we can fix it. The fear of needles is something we address every day. We have ways to help you get past this fear and to make the process less uncomfortable. Finally, the comment that some people would appreciate a blanket or a heated chair because the temperature in the office is too cool. Contrary to popular belief, we do not keep offices cooler to keep us awake. Instead, we keep the temperature relatively cool as part of an effort to reduce the spread of germs and bacteria. At this time, we do not have heated chairs. However, we do offer blankets if you tell us you are cold.

 

Category 2 was problems with the treatment. First, in this office, we do not reprimand patients over the way they care for their teeth. Second, we do not believe in beginning treatments that you do not understand or without discussing treatment options with you. We want you to know exactly what we are doing and why we are doing it. It is our practice to consider as many treatment options as possible for each patient. Some of those treatments are not feasible in every case. We typically eliminate those options and then discuss viable options with you before beginning a treatment plan. In this office, we want you to understand the options and participate in the decision-making process. We understand that there are many reasons for choosing one option over another.

 

Category 3 concerned problems with the office environment. This category included such issues as a small waiting area, not being called when we are running behind schedule, and being bored with the pictures on a video screen or the ceiling, to turnover of hygienists, to trying to sell people more or more expensive services, to making referrals to specialists and not communicating your information to them in advance. We have not heard complaints about the size of our waiting area. One of the reasons may be that patients typically do not wait long. We build our schedule for each day entirely around the patients we see and their needs. We do not just schedule people into 30- or 60-minute slots and hope for the best. If we discuss optional treatments or services to you, it is not an attempt to sell you something more expensive. We try to listen very carefully to each patient and then discuss with that patient options that may help us to achieve their goals – perfect teeth, whiter teeth, dentures vs implants, etc. When we find it necessary to refer patients to a specialist, we try to ensure that your information reaches that specialist in advance of your appointment. That said, however, we are typically able to provide “complete dental care” to our patients, with a minimum of referrals.

 

Category 4 reported issues with the staff of the practice. These complaints ranged from rudeness from staff members to overly friendly and chatty staff members to being asked silly questions, to being offended by a staff member’s breath. We try to be sensitive to your needs, your concerns, and to the issues you have with us. If you tell us that there is a problem, we will do everything we can to address the problem. We cannot guarantee, however, that we will not unintentionally ask silly questions, such as the one cited in the poll report: “I hate when they ask me, ‘Are you feeling okay?’ when they see a tear coming down my face.”

 

The final category was for issues related to billing. Two of the quoted responses in this group were important. The first was about being billed for a late cancellation: “I had an appointment scheduled for a checkup but had to cancel that morning because the previous night my husband had broken his leg. I had to take him to surgery that morning. I was billed, because it was not 24 hours in advance.” If we should ever make a mistake of this kind, please notify us. We have policies, but we never want to be so insensitive. The other important concern in this category was having explanations of procedures and their costs. We make every effort to explain each procedure and the cost. If you ask about less expensive options, we are more than happy to discuss them with you. At the same time, we will also explain why we believe a particular treatment option is best for the situation. But ultimately, the decision is yours.

 

We welcome reports of polls of this sort. We try to be a responsive as possible to every patient’s concerns and fears. But if you do not tell us about discomfort or unhappiness about something, we cannot address it. You should never be afraid to tell us how you feel, what you fear, or to ask any questions you need answered.

 

Finally, one of the most important concerns stated in response to the poll questions was this: “I hate that I am too old to get a ring from the [children’s] treasure chest.” We don’t like ageism either! If this is important to you and you feel you have earned such a reward, just tell us! On the other hand, you actually might prefer the items in the grownup’s goodie bag!

 

 
Your Dentist and Your Medical History

Many people visit their dentist’s office and refuse to answer questions about their medical history when asked by the Dental Hygienist. I’m not certain why. The most common responses people offer are “Nothing you need to know to clean my teeth,” or “Why are you asking me this to clean my teeth?” Dental Hygienists actually do much more than clean your teeth.

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First, your medical history, medication changes, and surgeries affect your teeth. Some conditions and medications cause dry mouth. If you are diabetic, it helps us to know that. We may then have additional questions that indicate to us that we should check for certain things while cleaning your teeth. If you have an autoimmune disease or another condition that causes inflammation, knowing your C-Reactive protein level or your Sed Rate alerts us that you are at some level of risk of developing periodontal disease.

Second, if we know your medical history, we can share helpful information with you about how to cope with the condition and minimize its effects upon your teeth.

Third, your “cleaning” is also an assessment of the condition of your teeth and gums. All of this information is shared with the dentist, who also uses it to explain issues and help you learn what you need to know about how these matters affect your oral health.

Other things that can affect your oral health, and should be shared with your dentist and your dental hygienist include:

  1. Allergies
  2. Whether you smoke, vape or use chewing tobacco
  3. Do you have any autoimmune diseases (thyroid disease, diabetes, Sjogren’s disease, lupus, Crohn’s disease or Rheumatoid Arthritis)?
  4. Do you have high blood pressure or high cholesterol?
  5. Do you have sleep apnea? Do you use a CPAP?
  6. Do you have an eating disorder?
  7. Do you have cancer?
  8. Were you ever exposed to chemical weapons, Agent Orange or other toxic chemicals?
  9. Do you have Lyme Disease?
  10. Do you have acid reflux? Are you taking antacids?

There are many medical issues and medications that have significant effect on oral health. The more we know about your medical history and current medical conditions, the better we can offer you the best information to help you care for your teeth and gums. We want to help you keep your teeth and prevent serious oral health issues. The more open you are with us about medical conditions the more helpful we can be.

 
Before you buy those mail-order braces . . .

there are things you need to know. 

The American Dental Association (ADA) has issued a warning about the use of mail-order aligners. Aligning or straightening of teeth is a complex process that requires regular management and adjustment to the device(s) in use. The use of mail-order aligners, however, is growing in popularity.

Most dentists and orthodontists use procedures and processes that gently and gradually move the teeth into position. Traditional braces - pixabay cco --tooth-366335 1280wire braces are adjusted frequently, and the complete process requires several months or even years. Invisalign and other invisible straightening products used by dentists are also replaced frequently in order to move the teeth gradually, gently, and safely. 

A business called “SmileDirectClub” has arisen (and others are sure to follow) as an alternative to dental or orthodontic care. Why do people choose this option? Clearly, one factor is cost. SmileDirectClub charges a one-time fee of $1,850 (or 24 monthly payments totaling $2,170). Invisalign, on the other hand, can cost between $3,000 and $8,000, depending on patient need. Another factor in the choice is the time involved in the frequent visits to the dentist for adjustments of the devices. 

We need to remember that dentistry requires the involvement of a trained and certified dentist or orthodontist. The do-it-yourself (DYI) approach can, and often does, cause more harm that good. In fact, some of the damage done by SmileDirectClub are irreparable. The Better Business Bureau has received 205 consumer complaints against SmileDirectClub during the last 36 months. Of the 19,000 orthodontists who are members of the American Association of Orthodontists, nearly 13 percent of their members are seeing patients who have tried the DYI program and endured some harm. Some of the patients who tried the DYI approach had suffered irreparable damage. 

Clearly, some of those who have tried the SmileDirectClub and its DYI approach believe the procedure is effective and successful. Others, however, have suffered harm of some kind. The harm ranges in type and extent. 

Before you click the “buy” button and order DYI aligners from a company you know relatively little about, please consider the risks involved in this approach. Instead, see a dentist or orthodontist who is trained, qualified and licensed to provide a safe and effective procedure. It is worth the additional cost to ensure that your teeth and gums are not damaged during the procedure.

 
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